Deep Brain Stimulation for Obsessive-Compulsive Disorder: Real World Experience Post-FDA-Humanitarian Use Device Approval

Abstract

Background: While case series have established the efficacy of deep brain stimulation (DBS) in treating obsessive-compulsive disorder (OCD), it has been our experience that few OCD patients present without comorbidities that affect outcomes associated with DBS treatment. Here we present our experience with DBS therapy for OCD in patients who all have comorbid disease, together with the results of our programming strategies.Methods: For this case series, we assessed five patients who underwent ventral capsule/ventral striatum (VC/VS) DBS for OCD between 2015 and 2019 at the University of Colorado Hospital. Every patient in this cohort exhibited comorbidities, including substance use disorders, eating disorder, tic disorder, and autism spectrum disorder. We conducted an IRB-approved, retrospective study of programming modifications and treatment response over the course of DBS therapy.Results: In addition to patients' subjective reports of improvement, we observed significant improvement in the Yale-Brown Obsessive-Compulsive Scale (44%), the Montgomery-Asberg Depression Rating Scale (53%), the Quality of Life Enjoyment and Satisfaction Questionnaire (27%), and the Hamilton Anxiety Rating scales (34.9%) following DBS. With respect to co-morbid disease, there was a significant improvement in a patient with tic disorder's Total Tic Severity Score (TTSS) (p = 0.005).Conclusions: DBS remains an efficacious tool for the treatment of OCD, even in patients with significant comorbidities in whom DBS has not previously been investigated. Efficacious treatment results not only from the accurate placement of the electrodes by the surgeon but also from programming by the psychiatrist.

Deep brain stimulation for treatment-refractory obsessive-compulsive disorder should be an accepted therapy in Australia

“…Four additional open-label studies in a further 100 participants have supported the aforementioned findings, with an average YBOCS reduction of 42%, 40%, 44% and 38 % after DBS of the ALIC/BNST (Denys et al, 2020;Kahn et al, 2021;Menchon et al, 2021;Naesström et al, 2021). An Australian case series of seven participants has also been published (Farrand et al, 2018).…”

An open-label prospective pilot trial of nucleus accumbens deep brain stimulation for children with autism spectrum disorder and severe, refractory self-injurious behavior: study protocol

“…The rapid expansion of DBS indications in adult pathologies has allowed for treatment of many psychiatric diseases [ 58 – 60 ]. It is expected that the adaptation of DBS for children will be feasible for SIB.…”

Clinical recommendations for the care of people with treatment-refractory obsessive-compulsive disorder when undergoing deep brain stimulation

“…Scientific evaluations have rarely reported on programming methods for DBS in OCD (Kahn et al, 2021; Widge and Dougherty, 2015), thus direct evaluation of stimulation parameters will provide empirical evidence to support expert guidelines (e.g. Okun et al, 2007).…”